Allergy sufferers know finding effective treatment can be tricky. The options are endless: antihistamines, decongestants, even natural remedies, such as a saline nasal irrigation. Find out which one’s right for you...

Are your allergies seasonal? Is it Fluffy? Or your food? Whatever the source, one thing is the same: They’re uncomfortable – if not debilitating – to deal with.

As many as 50 million of us suffer from allergic diseases, according to the American Academy of Allergies, Asthma and Immunology. Around 54% of Americans test positive for one or more allergens.

What can you do to relieve the distress? We talked to Maeve O’Connor, M.D., a specialist in allergy, asthma and clinical immunology at the Carolina Allergy & Asthma Center in Charlotte, N.C., for the latest in the allergy wars.

What exactly are allergies?Think of your immune system in two parts: One fights infection; the other responds to perceived threats, like allergens. Many substances act as allergens, including foods, pet dander, mold, ragweed or pollen. You’re typically exposed through the environment, as a fetus or eating.

So what happens in an allergic reaction? The first time your body is exposed to an allergen, nothing happens. The next time it’s exposed, the body starts producing antibodies called immunoglobulin E (IgE).

These antibodies circulate in the body, causing the release of histamines and other chemicals, such as leukotrines, which are immune mediators; they cause inflammation and allergy symptoms in the nose, lungs, throat, sinuses, ears, skin or stomach.

Are women more prone to allergies than men?Actually, men and women are pretty evenly split when it comes to allergies. But hormones can make allergies more challenging for women.

What effect do hormones have on allergies?It’s not the estrogen itself that can trigger symptoms, but changing estrogen levels can activate proteins that produce an inflammatory response, which exacerbates allergies.

These changes can occur during a woman’s menstrual cycle, perimenopause and menopause. Experts believe that nasal congestion often gets worse when estrogen levels rise. But there’s no way to predict how your allergies will change since women’s hormone levels vary.

Do these hormonal changes include pregnancy?During pregnancy, a third of women allergy sufferers will notice that their symptoms get worse, a third will see an improvement, and a third will have no change.

More sinus congestion can also be caused by expanding blood vessels in the nose and increasing blood volume in pregnancy.

Does stress affect allergies?Absolutely. Stress triggers the release of cortisol and other hormones, which can make you more sensitive to allergens. Studies have shown that even slight or moderate levels of anxiety and stress can worsen allergy symptoms.

Stress affects the immune system, raising levels of immune mediators that heighten allergic response. So patients may require more medication during stressful times than at other times.

Stress also can exacerbate skin allergies, including hives and eczema, and cause unexplained itching.

Are there other risk factors, like weight? Obesity doesn’t seem to worsen allergies. A family history of allergies is the biggest risk factor for developing them.

What health problems are linked to allergies?Women who have autoimmune diseases – Hashimoto’s thyroiditis, lupus, rheumatoid arthritis – are more likely to suffer from allergies. They’re all examples of immune system dysfunction. That’s why allergists and rheumatologists overlap a lot.

For example, hives can be caused by allergies, but also by autoimmune disease. I often diagnose autoimmune disease [even though] I’m seeing people for chronic hives.

More people these days seem to have food allergies. Is that a reality? Yes. One study cites an 18% increase in the incidence of peanut allergies over the past 10 years. The question is, why?

Some people believe that the use of hand sanitizers, the overuse of antibiotics and too much time indoors is skewing our immune systems. We’ve become less capable of separating harmful substances from safe ones. As a result, we’re overly sensitive to potential allergens.

We also have better testing now. But we have a lot of false allergy test results. People who aren’t certified by the American Board of Allergy/Immunology are doing tests and possibly not interpreting the results properly.

That’s why it’s important to have allergies treated by someone who specializes in allergies and immunology.

Is global warming really causing more allergies?Studies suggest it is. As the earth has gotten warmer, the pollen season has been extended, which makes allergies last longer. And the longer warm seasons have increased the incidence of bug bite allergies because certain insects thrive in warm climates.

Also, the warmer climate is causing higher ozone levels, which increase allergy and asthma problems – especially for people sensitive to outdoor allergens like pollen.

We’re having more pollen than ever. The pollen is so thick it’s acting like an irritant. It gets into the lungs and nasal cavity, creating symptoms.

I’ve even had non-allergic patients calling me complaining of coughing.

How can allergy sufferers get relief? Several ways: over-the-counter remedies, lifestyle strategies and prescription treatments, including shots.

Which over-the-counter remedies are best? Choosing the right one often requires trial and error. But these drugs aren’t without side effects, so talk to your doctor before using one. The drug you choose depends on your symptoms.

If you have seasonal allergies or hives, you might want to try an antihistamine such as cetirizine (Zyrtec), loratadine (Claritin) or diphenhydramine (Benadryl). These block the action of histamine [a substance produced by the body that causes an allergic reaction] and can stop the running nose, itchy eyes and sneezing.

For a stuffy nose, you may want a decongestant such as pseudephedrine (Sudafed). These work by narrowing your blood vessels and reducing the amount of fluid that leaks into the nose’s lining. Decongestants are sometimes combined with antihistamines.

But be wary of decongestants if you suffer from high blood pressure – they can boost it. And topical decongestants like Afrin shouldn’t be used for more than 3-4 days in a row; beyond that, they can worsen congestion.

For irritated, red or itchy eyes, I recommend eye drops specifically for allergies, such as ketotifen (Zaditor) and naphazoline (Naphcon A). But don’t [use] eye drops that remove the red – they won’t relieve the itch.

To get rid of red [eyes], [try] saline eye drops that don’t contain tetrahydrozolin – it’s a vasoconstricting chemical [that shrinks blood vessels]. Prolonged use can cause blood vessels to be dilated for an expanded period of time, which can cause a “rebound” effect that actually make redness worse.

When do you need a prescription drug? If OTC remedies don’t work or if side effects are intolerable. Severe allergies, for example, may require prescription antihistamines, drugs that modify inflammation-causing leukotrienes and/or nasal or systemic corticosteroids.

But again, tell your doctor about your other medications and health conditions. Certain allergy medications can’t be used by people who have high blood pressure or glaucoma – they may raise blood pressure (and pressure in the eye).

Are there any promising new drugs?There are a couple antihistamine nose sprays called azelastine (Astepro) and olopatadine (Patanase) that work really well at relieving congestion. They [supply] antihistamine directly to the nasal passage.

There’s also a new Zyrtec derivative called levocetirizine hydrochloride (Xyzal). It’s less sedating than Zyrtec and is also FDA-approved for chronic hives.

If someone doesn’t want to use drugs, what natural remedies do you recommend? I like the neti pot, an ancient treatment that irrigates the sinuses with saline – it’s wonderful.

At first, many allergy sufferers don’t like it, and it can be irritating. But after about a week, improvement in their nasal symptoms is obvious. They just need to stick with it. However, [using it] once a day is the maximum. If you notice any irritation, bleeding or drying, back off and only do it during the week, not weekends.

Some allergy sufferers espouse echinacea or locally produced honey as a remedy. But the evidence on those is weak.

Of course, there’s the placebo effect: If you’re eating local honey and you notice an improvement in your allergies, then I say go for it. The bottom line is, we need more studies on these homeopathic measures.

What lifestyle strategies or changes do you recommend? It depends on what’s setting off your allergies. If you suffer from dust mite allergies, I recommend vacuuming regularly and using dust mite encasements on mattresses and pillows. Women who travel a lot, for example, should always carry covers because hotel rooms are notorious for dust mites.

If a runny nose and outdoor allergens are the problem, don’t sleep with the window open or drive with the window down. Brush animals after they come inside. Wash your hair after spending time outdoors.

If you’re allergic to pet dander, try washing your pet more often – and ask someone else to do the job. Change the filters in your house regularly and never allow the animal to sleep in your bedroom.

When should someone consider allergy shots? If you’ve tried all the above measures and you’re still not getting relief, or you require multiple medications, call an allergy and immunology specialist. Shots are recommended if your allergy symptoms are really bad or if you have asthma.

[The shots are] a form of desensitization therapy, which dampens the immune response to an allergen. After 3-5 years, you can usually stop the shots and be completely symptom-free.

They’re about 85% effective at providing relief. Effectiveness depends on the severity of a person's allergies and the number of substances to which the person is allergic.

Patients taking shots are often able to stop their allergy medications or use them "as needed," instead of daily.

Also, the shots have been proven to stop the "allergic march" in children – preventing allergic children from developing asthma.

Isn’t there a treatment that doesn’t involve shots?Like allergy shots, sublingual immunotherapy, or SLT, desensitizes you to allergens, but by putting liquid drops of the allergen under your tongue. SLT studies are promising but not complete. It hasn’t been approved by the FDA, but it’s being used in Europe with some success.

So far, SLT is considered less effective than shots. But it's a simpler treatment because allergy sufferers can do it at home.

Both shots and SLT expose an allergic person to the allergen. Can someone do food exposure treatments at home?No. If you’re allergic to a food, it’s way too dangerous to do this yourself at home. Duke University has had promising results with food allergies in children, particularly peanut-allergic children. But these are tightly controlled studies with carefully administered dosages of peanuts.

There’s always a risk of death if you eat something you’re allergic to.

Oral challenges should be performed in the office of an allergist who has been board-certified by the American Board of Allergy and Immunology. At this point, desensitization to food allergens is for research purposes only.

What’s Your Allergy IQ?Ignorance may be bliss, but not when it comes to a stuffy, sneezy, scratchy problem like allergies. Maybe you suffer from seasonal allergies. Or perhaps the bed bugs really are biting. Do you know what’s making you itch? Find out with this allergy quiz.

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